Provider Demographics
NPI:1861031015
Name:PRIORITY HEALTH MEDICAL CENTER
Entity Type:Organization
Organization Name:PRIORITY HEALTH MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:MYRTIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-250-9490
Mailing Address - Street 1:3660 CENTRAL AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-7647
Mailing Address - Country:US
Mailing Address - Phone:239-689-6697
Mailing Address - Fax:239-689-6703
Practice Address - Street 1:3660 CENTRAL AVE STE 6
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-7647
Practice Address - Country:US
Practice Address - Phone:239-689-6697
Practice Address - Fax:239-689-6703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-04
Last Update Date:2020-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty